Background and Aims
Endoscopic bariatric therapies are less-invasive alternatives to bariatric surgery,
and endoscopic gastroplasty (ESG) represents the latest evolution. This study aims
to compare weight loss, safety, and comorbidity resolution of ESG compared with laparoscopic
sleeve gastrectomy (LSG).
Methods
This was a propensity score–matched study of patients who underwent ESG or LSG. Primary
outcome was weight loss at 6, 12, 24, and 36 months. A noninferiority margin of 10%
total weight loss (%TWL) was used. Secondary outcomes were safety and comorbidity
resolution.
Results
A 1:1 propensity score match yielded 3018 patient pairs. Average age and body mass
index (BMI) were 34 ± 10 years and 33 ± 3 kg/m2, respectively, and 89% were women. Mean percentage of excess weight loss at 1, 2,
and 3 years after ESG was 77.1% ± 24.6%, 75.2% ± 47.9%, and 59.7% ± 57.1%, respectively.
Mean percentage of excess weight loss at 1, 2, and 3 years after LSG was 95.1% ± 20.5%,
93.6% ± 31.3%, and 74.3% ± 35.2%, respectively. The mean difference in %TWL was 9.7%
(95% confidence interval [CI], 6.9-11.8; P < .001), 6.0% (95% CI, –2.0 to 9.4; P < .001), and 4.8% (95% CI, –1.5 to 8.7; P < .001) at 1, 2, and 3 years, respectively. Noninferiority was demonstrated at all
follow-up visits. Fourteen ESG patients developed adverse events (.5%) versus 10 LSG
patients (.3%). Comorbidity remission rates after ESG versus LSG were 64% versus 82%
for diabetes, 66% versus 64% for dyslipidemia, and 51% versus 46% for hypertension,
respectively. Eighty ESG patients (2.7%) underwent revision to LSG for insufficient
weight loss or weight regain, and 28 had resuturing after primary ESG (.9%).
Conclusions
ESG induces noninferior weight loss to LSG with similar comorbidity resolution and
safety profiles.
Graphical abstract
Graphical Abstract
Abbreviations:
BMI (body mass index), ESG (endoscopic sleeve gastroplasty), LSG (laparoscopic sleeve gastrectomy), MBS (metabolic/bariatric surgery), %TWL (percentage of total weight loss)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 02, 2022
Accepted:
February 28,
2022
Received:
June 24,
2021
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure gender balance in the recruitment of human subjects. We worked to ensure ethnic or other types of diversity in the recruitment of human subjects. We worked to ensure that the language of the study questionnaires reflected inclusion. One or more of the authors of this paper self-identifies as an under-represented gender minority in science. One or more of the authors of this paper self-identifies as an under-represented ethnic minority in science. While citing references scientifically relevant for this work, we actively worked to promote gender balance in our reference list. The author list of this paper includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
If you would like to chat with an author of this article, you may contact Dr Alqahtani at [email protected]
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